Abstract
Objectives: Cervical inter-laminar injections at C7-T1 have been routinely performed for many years as an effective means of palliating neck pain. The purpose of this study is to measure the extent of contrast spread following C7-T1 cervical inter-laminar epidural steroid injection (CIESI), and to correlate the upper extent of contrast spread with degree of cervical spinal stenosis. Methods: We retrospectively identified 41 consecutive patients over a six months’ time frame fulfilling the following inclusion criteria: (1) Had image guided CIESI at C7-T1, (2) Had PA and oblique epidurogram pre and post procedure, (3) Had procedural notes indicating the amounts injected and (4) Had an antecedent MRI. The epidurograms were reviewed for their extent of injectate spread. MRI studies were evaluated separately and blinded to the epidurograms. For each level the degree of cervical spine narrowing was noted. We correlated the extent of contrast spread with the level of maximal cervical narrowing. Results: Maximal contrast spread was up to the skull base and down to T4-T5; minimal extent was C6-C7 to T2. We found statistically significant correlation (2-tailed Pearson correlation r= 0.867, p<0.001) between the upper-most extent of contrast spread and the lowest level of significant central canal stenosis according to pre-procedure MRI. Conclusion: Following CIESI injectate will spread up as far as the cranio-cervical junction or near the lowest level where there is moderate degenerative central stenosis.
Highlights
Neck pain is a common disorder in adult population
Inter-laminar injections are generally safely performed at C7-T1 or, in rare cases at C6-C7
The purpose of this study is to measure the extent of contrast spread following C7-T1 inter-laminar injection, and to correlate the upper extent of contrast spread with degree of cervical spinal stenosis
Summary
Neck pain is a common disorder in adult population. Up to 30-50% of adults will experience neck pain in any given year [1] and recurrent pain may develop in 50-75% of those within 1-5 years [2].CIESI (Cervical Inter-laminar Epidural Spinal Injections) are used to treat a variety of neck pain disorders such as, degenerative cervical radicular pain (discogenic or not), spinal stenosis, and nonspecific, degenerative chronic neck pain [3,4]. Neck pain is a common disorder in adult population. In patients presenting with a multilevel pathology, inter-laminar route to the epidural space, allows a multilevel spread of corticosteroids, enabling treatment. Inter-laminar injections are generally safely performed at C7-T1 or, in rare cases at C6-C7. At those levels, the posterior epidural space is the largest [6] (Figure 1). As the rationale behind interventional steroid injections is maximizing efficacy by delivery of the injectate as close as possible to the site of disease, it is imperative to know what presumably will the upper extent of the injectate be, and whether it reaches the suspected pain generating level
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
